Related Experiment Videos
Normal coronary angiogram and dobutamine-induced left ventricular obstruction during stress echocardiography: a
L Christiaens1, C Duplantier, J Allal
1Département de Cardiologie, Centre Hospitalo-Universitaire de Poitiers, 350 Avenue Jacques Coeur, BP 577, 86021 Poitiers Cedex, France. l.christiaens@chu-poitiers.fr
Insights
Dynamic left ventricular obstruction (LVO) is common during dobutamine echocardiography (DE) in patients with chest pain but no coronary artery disease. This finding is linked to a greater hemodynamic response to dobutamine.
Area of Science:
- Cardiology
- Echocardiography
- Diagnostic Imaging
Background:
- Dobutamine echocardiography (DE) is used to diagnose coronary artery disease (CAD).
- Dynamic left ventricular obstruction (LVO) can occur during DE, particularly in patients with ischemic conditions.
- Understanding factors predicting LVO in non-CAD patients is crucial.
Purpose of the Study:
- To identify clinical and echographic factors predisposing to dynamic LVO during DE.
- To investigate the occurrence of LVO in patients presenting with angina-like chest pain but without significant CAD.
Main Methods:
- DE was performed on 52 patients (mean age 61 years) with chest pain and normal coronary angiograms.
- Dobutamine was administered at doses of 5-40 microg/kg/min.
- Dobutamine-induced LVO was defined as a new intracavitary flow acceleration ≥ 3 m/sec in the left ventricle.
Main Results:
- Dynamic LVO occurred in 38% (20/52) of patients.
- LVO was not associated with clinical or baseline echocardiographic parameters.
- Higher chronotropic response and systolic blood pressure during DE, along with more frequent chest pain, were observed in patients with LVO.
Conclusions:
- Dynamic LVO is a frequent finding during DE in patients with angina-like chest pain and no epicardial CAD.
- The presence of LVO during DE is associated with increased hemodynamic responsiveness to dobutamine.
Unlabelled:
This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina-like chest pain but without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients.
Methods:
DE (5-40 microg/kg/min) was performed in 52 consecutive patients with angina-like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 +/- 10 years (27 men, 25 women). Dobutamine-induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle.
Results:
Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02).
Conclusion:
Dynamic LVO is common during DE in a population of patients with angina-like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.